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Contact Information

KENNETH W KING JR, OD
1480 E LINCOLN RD
IDAHO FALLS, ID83401-2128
 Phone: 208-525-8686
 Fax: 208-525-8684
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Corneal and Contact Management

152WC0802X 41 Optometry
Indicates primary specialty

NPI Profile & details for KENNETH W KING JR · (Male)

NPI Number 1174524722
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 08/04/2005
Last updated 12/20/2013 - About 12 years ago
Sole proprietor 1 Yes
Identifiers
  • ID License # ODP0467
  • ID Medicaid 002543100
  • Other I-902428 CHAMPUS
  • Other 0605250001 DMERC
  • ID Other 82052 BLUE SHIELD
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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